What is this thing we call peer support?

Gene Johnson is CEO and President of Recovery Innovations, Arizona. This blog post is an extract from Gene’s keynote speech at April’s The role of peer workers in mental health services conference, jointly organised by the Centre and the NHS Confederation. Changing the balance between traditional mental health professionals and people whose expertise comes from ‘lived experience’ in mental health services is key to the concept of recovery. Peer specialist roles are different from, but equal to, traditional service roles.

In 1999 I had the idea that what was happening in the peer run services, like the drop-in centres, was really good, but no one was paying much attention to it. It wasn’t very well funded and often times at risk in terms of business or infrastructure. So I thought: what if we can team up? What if the peers could come over and join our teams?

In October 1999 we trained 15 people. By the end of that year we had 66 peers on our teams and that’s when things started to change. There was a new level of hope and engagement. If she can do it, if he can do it, so can I. That’s the credibility that comes from the lived experience, right? A profound sense of empathy.

So we got out of the mindset of ‘being the expert’ and we stopped thinking that our job was to fix people because our peers on our teams would say ‘No, the real job is to be with people, just walk beside people,’ and, if we provide that level of mutuality and support, people find their own way.

The tipping point – that’s the transformation point. We say it is a minimum of 25% of peers on the workforce. Today 62% of our employees are peers, working in dedicated peer support jobs. They’re not the driver or the receptionist or working in the file room; they’re providing peer support with their peers.

Some of the results: The first thing that we noticed was the peer support specialist’s own recovery improved rapidly. Now this was an amazing thing. We thought therapy was the answer, we thought counselling was the answer, we thought treatment was the answer. You know what the answer was? It was a meaningful job. It was a pay cheque. It was the self-esteem that came from making a contribution.

So this year, a few months ago, we did an anonymous Internet survey of all our peer employees. 253 employees responded; a 70% response rate. Prior to their employment with us two thirds of them didn’t have a job. Over a third of them had been unemployed for more than three years. For many there was long-term unemployment. The average number of hours worked was 30 hours, so we have a mix of full-time and part-time employees depending on what works for the individual. 20% of the people in the group went off their disability benefits and gave up their disability pensions. Now that is revolutionary. I didn’t know this could happen. I don’t know how it is here but in the US we see less than 1% of the people on disability payments going off disability. Another 37% reduced their disability payments, 45% went off Medicaid, the public healthcare system and discontinued housing subsidies, food stamps and so forth. The financial impact of this? This should be front page news. I think we played a trick on the system because $8 million in salaries for our peer employees that was previously going to their mental health treatment is now going into their pay cheques. It’s still mental health money because this really improves the quality of their life. $1.2 million paid in income taxes, half a million dollars of reduction savings in disability payments. This is a no-brainer!

But what about some of the other things that they reported? 87% said “helping others has helped my own recovery; I feel more confident; I’m more emotionally stable; I’m more satisfied with life in general.” 68% are interested in future career opportunities and that’s what recovery is, it’s moving on. Able to connect with family; socialise with friends; to begin saving money. Taken a paid vacation – how cool is that? One person says ‘I went to the Grand Canyon, I had someone house sit for me because I have a dog and I drove my own car.’ That’s what recovery is, right?

Peer support specialists help others recover. I’ve talked a little bit about that. When we put the peer staff on the nine units at our County Hospital, we had two peer support specialists working on each unit every day. They were providing peer support. They did an orientation to recovery meeting and they did something they call the ‘discharge recovery plan’ which was an effort to really work out the practical issues involved in leaving the hospital- because they knew what it was like not knowing who was going to pick you up, not to know what was happening to the mail in your mailbox or the backpack behind your case manager’s desk. After a year the hospital reported a 56% reduction in readmissions. Now this was not a scientific study but the only thing that had changed in that hospital was that the peers were there. The reduction in seclusion and restraint in the hospital happened because of the increased accountability that shows up on teams when someone with that lived experience speaks up.

Peer support specialists help the system recover. Now, if you’re working in a hospital, if you’re working in a crisis service, you may never see people that have recovered and your perspective gets off-balance. So as we begin to have peers, people in recovery showing up every day, contributing and making a difference on those teams the staff begin to say ‘Oh, recovery is real. There it is, look at John.’ And it helps us to confront our own stigma.

Risk, Safety and Recovery argues that risk and safety are rightly major concerns in mental health care but that traditional clinical management methods of assessing risk have stood in the way of helping people to recover their lives.

Perinatal mental health problems carry a total cost to society of about £8.1 billion for each one-year cohort of births in the UK. But the NHS would need to spend just £337 million a year to bring perinatal mental health care up to the recommended level.